PhD/PsyD Client early termination- how to cope?

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Anxious20

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Hi everyone! I am a newly licensed psychologist who joined a group private practice about 4 months ago. So far, I've had 4 clients who informed me that they wanted to discontinue treatment after 2-4 sessions in. Not all of them provided a clear rationale and the ones that did say they preferred an older therapist or that the treatment wasn't a good fit. I can't help but think that I must be doing something wrong and I am not sure what I could have done differently. I am wondering how other people copel with early termination.

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Depends of the population and type of work I suppose. The fact they are telling you is good. In my kind of work people just no show and become unresponsive to outreach.

Isn't there research out there showing people tend to only come for 1-2 sessions a majority of the time anyways? Or am I mis-remembering some random article I may have read years back in grad school
 
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By and large, as AbPsych stated, many people do not stay around for a full course of treatment. Did this not happen to you often enough in training when you were receiving supervision? How did you and your supervisors process this when it happened in training?
 
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In the VA they're called provider change requests and we get them all of the time. It's important to remember that it's not 100% you, it's a relationship and they have their part in it, too. I know that it hurts, but try not to take it too personally. Do some CBT work on yourself if you have to. :)
 
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At least they are giving you the courtesy of telling you they want to discontinue rather than bailing and going ghost mode.
 
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Truth is, I don't really care. On the flip side, I have never put myself in the financial situation where I am reliant on client pay to eat. When I did cash PP, I kept an insurance based contract position to cover the basics. I am currently salaried, so I don't care that much.

I think the question here is why are you having trouble coping. 4 clients out of how many? Are you struggling to get started or just obsessing over this despite a healthy caseload. Is this normal for the practice area you work in?
 
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From a hopeful perspective: They could have also improved enough to warrant not sacrificing the time.

Howard (1984); 10-18% patients improve prior to the first therapy session; after 2, 8, and 26 sessions, 30%, 53%, and 74% of patients, respectively.

Barkham (1996): 50% depressed pts reach a clinically significant change in symptoms after 8 sessions

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This happens here and there. I frame therapy from the start as a “goodness of fit” and tell people it takes about 3-4 sessions to have a sense of whether you’re a good fit to work together, which reflects alliance research but also gives therapists wiggle room to refer out of a client’s issues are far more acute or complex than initially presented. Sometimes you just aren’t a good match, the person isn’t ready to do the work, or doesn’t have the insight/motivation. While it’s frustrating, I wouldn’t worry about it unless it is consistently happening with a highish percentage of clients and/or you notice a pattern of it happening with X group of people.

One thing I’ll also add is that in PP vs. other sites, people also end more abruptly via a call or email far more than other sites I’ve worked at, and it’s not just awkwardness of ending, but to some clients, financially doesn’t make sense for them to pay $150 to say goodbye to their therapist. Although I’d certainly like to process our work together and reflect, our clients don’t necessarily need or want that at the very end. Some will, some won’t, so try to keep that in mind as well so that you don’t take it personally when someone you’ve worked with for awhile and has improved stops coming rather abruptly and leaves a quick voicemail to say they’re done. Hopefully you’ve been soliciting feedback and reflecting on work together along the way anyway.
 
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So far, I've had 4 clients who informed me that they wanted to discontinue treatment after 2-4 sessions in.

Is this in-person therapy with masks on? Or telehealth? I'm curious what parts of your scenarios are related to COVID compliance, and how they're having an impact on the therapeutic process itself? Honestly, I think everyone has done a great job, whipping things into gear, but it's not the same (when it's telehealth versus inperson). But, again, none of us have ever experienced a Global Pandemic...so we're doing the best we can.
 
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By and large, as AbPsych stated, many people do not stay around for a full course of treatment. Did this not happen to you often enough in training when you were receiving supervision? How did you and your supervisors process this when it happened in training?
Interestingly, this did not happen to me when I was in training, and I never had to process this with a supervisor.
 
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Is this in-person therapy with masks on? Or telehealth? I'm curious what parts of your scenarios are related to COVID compliance, and how they're having an impact on the therapeutic process itself? Honestly, I think everyone has done a great job, whipping things into gear, but it's not the same (when it's telehealth versus inperson). But, again, none of us have ever experienced a Global Pandemic...so we're doing the best we can.
That's a good point. I've been doing telehealth since I started and I can see how it may be more difficult to establish alliance versus in person
 
Interestingly, this did not happen to me when I was in training, and I never had to process this with a supervisor.

Wow is all I really have to say to that. It's a very common phenomenon, so, I'd try to not take it personally. If it keeps happening and still bothers you, seek out some peer consultation perhaps.
 
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Wow is all I really have to say to that. It's a very common phenomenon, so, I'd try to not take it personally. If it keeps happening and still bothers you, seek out some peer consultation perhaps.
Yes, I already did actually! Thank you so much!!!
 
I believe the great psychologist character Robert Wiley stated it best:

“if I meet somebody who I don’t think likes me I say to myself, ‘Bob, this one is temporarily out of order.’ Don’t break the connection just hang up and try again.”

(Old people and Bill Murray fans will recognize the what about bob quote)
 
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Hi everyone! I am a newly licensed psychologist who joined a group private practice about 4 months ago. So far, I've had 4 clients who informed me that they wanted to discontinue treatment after 2-4 sessions in. Not all of them provided a clear rationale and the ones that did say they preferred an older therapist or that the treatment wasn't a good fit. I can't help but think that I must be doing something wrong and I am not sure what I could have done differently. I am wondering how other people copel with early termination.
“Bye felicia”
 
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